People with mental illness less likely to get cancer screening

By Vishwadha Chander

(Reuters Health) - People with mental illness get screened for cancer at much lower rates than the general population, which may contribute to higher rates of cancer deaths among the mentally ill, researchers say.

In a review of 47 previous studies covering 4.7 million people in 10 countries, the study team found that adults with mental health issues were 24% less likely overall to get screened for cancer compared with the general population.

The disparities were greatest among women with schizophrenia, who were roughly half as likely as women in the general population to be screened for breast cancer.

"The most significant finding is women suffer from these disparities, in particular, those with schizophrenia," lead author Dr. Marco Solmi, a psychiatrist and researcher at the University of Padua in Italy, told Reuters Health.

Early cancer screening has been shown to reduce mortality, and delayed cancer diagnosis among people with mental illness could be one reason they are also more likely to die of cancer than the general population, Solmi and colleagues write in The Lancet Psychiatry.

Cancer screening rates were poor even among people with more common mental health issues like mood disorders, they found. Disparities were also largest in places where healthcare has improved the most for the general population.

The analysis included 501,559 adults with mental illness and 4.2 million in the general population of the Americas, Asia, Australia and Europe.

Solmi's team looked at screening rates among people with depression, schizophrenia and mixed mental disorders, and at screening for all cancers, as well as breast, cervical and prostate cancers specifically.

They found that women with schizophrenia were 48% less likely than those in the general population to be screened for breast cancer, and 25% less likely to be screened for cervical cancer.

People with schizophrenia were also, in general, about 38% less likely than the rest of the population to receive screenings for any cancer.

Men with any mental illness were 22% less likely overall to be screened for prostate cancer. Women with any mental illness were 35% less likely to be screened for breast cancer and 11% less likely to be screened for cervical cancer.

Colon cancer screening was the only category that did not show an overall disparity, the study found.

The authors say better coordination between mental health specialists and primary care professionals could help to close screening gaps.

"A possible approach to increase cancer screening rates among people with mental health issues may be to have case managers, nurses, social workers or other professionals who are given clear indications by doctors on what screenings are necessary and with what frequency," Solmi said in an email.

"Case managers can keep track of patients with mental illness and encourage them to comply with screening calendars."

Access could be another problem.

"Many patients with severe mental illnesses live in areas with little access to cancer screening centers," said Dr. Steven Dubovsky, chair of psychiatry at the State University of New York at Buffalo, who wasn't involved in the study.

"People may not have cars, public transportation may not be good enough to reach a cancer screening center and the average doctor's office may not have the facilities for basic cancer screenings such as a mammogram," he told Reuters Health in a phone interview.

"Patients with severe mental illnesses have other things on their minds, like how to function every day, beyond when to schedule a mammogram or prostate exam," he added.

Dubovsky agreed on the need for closer collaboration between medical and psychiatric health providers but pointed out they don't get paid for collaborating care. "Lawmakers must see the benefits of collaborative care and put some money into it."

Better outreach by hospitals could be a solution, said Dr. Paul Thielking, director of psycho-oncology at the Huntsman Cancer Hospital in Salt Lake City, Utah, who wasn't involved in the study.

"Most people get cancer screening done in primary care offices, and people with serious mental health issues may not access primary care doctors often and their mental health provider may not do cancer screening."

SOURCE: and The Lancet Psychiatry, online November 28, 2019.